Selected essays and monographs : translations and reprints from various sources.

Date:
1897
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Licence: Public Domain Mark

Credit: Selected essays and monographs : translations and reprints from various sources. Source: Wellcome Collection.

    165/476 (page 149)
    DIAGNOSIS FROM DERMATITIS HERPETIFORMIS. The eruption in the mouth was very extensive; it implicated the mucosa of lips, cheeks, the frsenum linguae, gums, hard and soft palate, extending to the posterior wall of the pharynx and introitus laryngis. The erosions were confluent in places, covered with greyish-white or yellow sloughs, which could be readily detached. Around them there was a vivid red and painful halo. Around the teeth the eruption formed a vesicular festoon, but on the velum palati the erosions were more discrete.* In spite of the similarity of this disease with dermatitis herpetiformis (first described and named by L. Duhring,t of Philadelphia), to which I prefer the older name hydroa pruriginosa (Tilbury Fox) as being more descriptive, L. Duhring and Brocq j have accentuated four cardinal points of difference. The rash is polymorphic in character, i.e., macular, vesicular, or bullous, and with a distinct herpetic distribution. Cutaneous and deep-seated partesthesite are frequently present not only during but also between the attacks, which in spite of these subjective symptoms leave the general health undisturbed. Dermatitis herpetiformis at rare intervals affects the buccal and * It is remarkable that Hebra did not recognize this localization on the mucosai, or even the febrile disturbance that is never absent in extensive attacks of herpes. He writes, “In patients suffering from herpes there is no fever; gastric and cerebral symptoms are absent; the mucosas are unaffected, and no changes occur in serous or fibrous structures ” (loc. cit., p.322). E. Besnier (loc. cit., p. 363) gives an excellent description under the name of Eryth'eme Hydroa Muscoscc, as also Quinquand, in Annal. de Dermat., 1882, who adopts Bazin’s term, liydroa buccalis. Furthermore, extensive outbreaks of herpes iris are perhaps less liable to be taken for syphilis than those circumscribed, afebrile attacks often alternating with erythema multiforme (cf. two recent cases recorded by Baudouin, hydroa buccalis pseudo-syphiliticus : Soc. Franc, de Derm, et Syphilig., May 8, 1890; Annal. de Dermat. et de Syph., 1890, p. 433; Sem. Med., 1890, p. 174.) t Phil. Med. Times, 1884; New York Med. Journal, 1884 and 1887, and in Monatsh. f. prakt. Dermat., vol. vii., p. 158. + Dermatitis herpetiformis of Duhring [syn., Hydroa bulleux (Arthridides bulleuses) of Bazin ; Pemphigus pruriginosus of Hardy; Hydroa pruriginosa of Tilbury Fox], by L. Brocq (Annal. de Dermat., 1888). In his paper Brocq terms the eruption “ chronic recurrent pruriginous polymorphic dermatitis ” ; in a later one (Internat. Dermat. Cong., Paris, 1889; Monatsh. f. Dermat., vol. ix., p. 215) he substitutes the name “Dermatitis polymorplie dolorosa,” which,'though descriptive enough, is too long. I do not agree with Besnier (Nomenclature des Pemphigoides, 1. c., p. 831), who objects to the proposal of Crocker and of Unna to term the disease “ hydroa.” Besnier says this term is too elastic, and he uses it adjectivally as erythema hydroa (in place of Bazin’s hydro-vesiculeux) for herpes iris. R. Bergh’s (1. c.) suggestion to find a new name for “ Duhring’s disease, ’ because he thinks hydroa (febrilis) of Peter Frank is often used synonymously for herpes facialis, is likewise unnecessary. Hydroa pruriginosa for German writers at least, is sufficiently distinctive.